We were fascinated to come across a Madeleine Portwood presentation on the Food for the Brain site [PDF]: discussing “Essential Fats, School Performance and Behaviour”. One quote stands out, repeated on two slides alongside pictures of very sweet-looking children:

this is not about chemistry. This is about children.

At a first glance, this sounds very compelling: after all, who could argue with the fact that educational psychology in our schools needs to be about children? However, the dichotomy invoked by Portwood here is extremely problematic. A brief discussion of the Cochrane Collaboration will help to make clear why.

shows the results of a systematic review of RCTs of a short, inexpensive course of a corticosteroid given to women about to give birth too early. The first of these RCTs was reported in 1972. The diagram summarises the evidence that would have been revealed had the available RCTs been reviewed systematically a decade later it indicates strongly that corticosteroids reduce the risk of babies dying from the complications of immaturity. By 1991, seven more trials had been reported, and the picture had become still stronger. This treatment reduces the odds of the babies of these women dying from the complications of immaturity by 30 to 50 per cent.

Because no systematic review of these trials had been published until 1989, most obstetricians had not realised that the treatment was so effective. As a result, tens of thousands of premature babies have probably suffered and died unnecessarily (and needed more expensive treatment than was necessary). This is just one of many examples of the human costs resulting from failure to perform systematic, up-to-date reviews of RCTs of health care.

Research is about both chemistry and children. Because of suboptimal evaluation of the research into how particular chemicals worked in particular situations, a number of babies will have died who might otherwise have been saved.

It is because we care about children – and because children are important – that we need to insist that research conducted in children and on childhood conditions meets the highest possible standards. At best, poor quality research will waste time, goodwill and resources while failing to generate useful results (step forward and take a bow, Durham fish oil initiative). Suboptimal research – or interpretation of this research – may lead to time and resources being wasted on deploying useless interventions in large numbers of children. At worst, problems with the research may lead to children being exposed to harmful interventions and/or denied useful interventions.

When researching interventions such as fish oil pills, one does not need to decide between chemistry and children. It is because children are so important that it is vital to get the research right. When poor quality research and interventions without good evidence are promoted with cries of ‘think about the children’, it is all-too-often the children who suffer. Professionals such as Portwood have a responsibility to think about the research, the chemistry and the children.

Hmmm. I’m all for patient-oriented outcome measures, and often fairly sceptical about proxy endpoints. However, the way that poor research (such as the Durham fish oil initiative) has been ‘justified’ in the past does make me cautious about ‘it’s about the children, not the chemistry’ type claims.

Disclaimer

At the risk of sounding like Arthur Weasley, information on this blog is not intended as a substitute for advice from a qualified medical practitioner. If you have health concerns, see a Dr or dietician (a blog is not the place to diagnose a health problem).